Lockdown has meant more and more people sitting around at home. This prompted Dr Simon Paul, Consultant Rheumatologist to do a webinar about Coccydynia for GPs and therapists. Here he shares a summary of the session. To view the webinar in full, see link at the end of the article.
What is coccydynia?
Exactly what it says on the tin! It is a symptom, not a diagnosis, of pain in the coccyx, and has been formally described for over 150 years. In fact, during the 1950s it was described as a “television disease”, likely due to sufferers sitting and developing poor postures during a decade that saw TV ownership grow fifteen times.
What are the symptoms and signs?
Patients often describe pain right at the tailbone, especially when sitting on hard surfaces and when getting up from a seated position. Patients may also experience pain during defecation, intercourse or when riding bicycles or motorcycles with hard saddles. Predominantly seated sports such as cycling, and rowing can lead to this condition.
Neurology will be normal, but a hallmark feature is coccygeal tenderness. The absence of coccygeal tenderness really should make one think of other diagnoses.
How common is it?
It typically affects those in their middle years and is more common in those who are overweight or obese. It probably accounts for less than 1% of all back pain, but interestingly it is more prevalent in women. This may be related to the positioning of the female coccyx lying more posteriorly in the female pelvis and therefore being more prone to external trauma. It is also more common in women because of injuries related to giving birth.
What are the causes?
By far the most common cause is trauma e.g. due to childbirth or a fall, or a rough landing on a water slide.
Much rarer, but more serious causes must also be kept in mind and these can include:
- coccygeal infection
- fracture
- arthritis
- tumours
One must remember other serious pathologies within the abdominopelvic regions can masquerade as coccygeal pain, as can lumbar disc disease. It is important to rule out infection or possible rectal/pelvic disease and refer urgently if there are any red flag features.
In about a third of patients, coccydynia is idiopathic. Investigations may include blood tests, X-rays and MRI scans.
How can it be treated and what is the prognosis?
The majority of patients settle down within a couple of months with conservative management, which includes self-care. For example:
- avoiding sitting on hard surfaces
- not wearing tight-fitting clothes
- trying sitz baths,
- taking care of posture
- using coccygeal cushions which encourage less weight to be taken through the coccyx
Other treatments to be considered include physical therapy modalities, including massage and mobilisation, extracorporeal shockwave therapy. Patients can try over the counter painkillers if safe to do so.
Topical Capsaicin, non-steroid anti-inflammatory medication, sacrococcygeal and pericoocygeal injections and ganglion blocks may be tried for more refractory cases under specialist management. Dorsal root ganglion stimulation has been attempted for other conditions and there is some evidence to suggest that this may help with coccydynia.
Very rarely, patients may be referred for surgery although this can be associated with prolonged recovery times and a high complication rate.
Some patients with chronic symptoms may develop psychological features, so it’s important to recognise these and treat/refer as needed.
Onward referral is mandatory if there are any red flag features.
Dr Simon Paul, Consultant Rheumatologist, is expert at treating this condition.
For more information visit:
Dr Simon Paul – London Sports Orthopaedics
To view the Webinar (kindly hosted by HCA Healthcare UK) CLICK HERE